Duan X F, Shang X B, Tang P, Jiang H J, Gong L, Yue J, Ma M Q, Yu Z T
Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China.
Zhonghua Wai Ke Za Zhi. 2017 Sep 1;55(9):690-695. doi: 10.3760/cma.j.issn.0529-5815.2017.09.010.
To evaluate the lymph node metastasis (LNM) pattern and related prognostic factors for T1 esophageal cancer. Clinical data of 143 cases of pT1 esophageal cancer patients (120 male and 23 female patients with median age of 60 years) who underwent esophagectomy and lymph node resection during January 2011 and July 2016 at the Department of Esophageal Cancer of Tianjin Medical University Cancer Institute and Hospital were reviewed, including 50 cases of T1a patients and 93 cases of T1b patients. The LNM pattern was analyzed and the prognostic factors related to LNM were assessed by χ test and Logistic regression analysis. Of 143 patients, 25 patients had LNM. The LNM rates were 17.5% for pT1 tumors, 16.0%(8/50) for pT1a tumors, and 22.6%(21/93) for T1b tumors. Of 25 patients with LNM, one patient had cervical metastasis, 15 patients with thoracic metastasis, and 17 patients with abdominal metastasis. The relatively highest LNM sites were laryngeal recurrent nerve (8 cases), left gastric artery (8 cases), right and left cardiac (6 cases) and thoracic paraesophageal (5 cases). Logistic regression analysis showed that the depth of tumor infiltration (=4.641, 95% 1.279 to 16.836, =0.020), tumor size (=5.301, 95% 1.779 to 15.792, =0.003), tumor location (=3.238, 95% 1.248 to 8.401, =0.016), and tumor differentiation (=5.301, 95% 1.719 to 16.347, =0.004) were independent prognostic factors related to LNM for T1 esophageal cancer. Tumor size (=4.117, 95% 1.228 to 13.806, =0.022) was an independent risk factor related to thoracic LNM, and the vessel invasion (=6.058, 95% 1.228 to 29.876, =0.027) and tumor location (=8.113, 95% 1.785-36.872, =0.007) were independent prognostic factors related to abdominal LNM. T1 esophageal cancer has a relatively high LNM rate, and the depth of tumor infiltration, tumor size, tumor location and tumor differentiation are correlated with LNM. The LNM risk and extent must be considered comprehensively in decision-making of a better surgical treatment and lymph node resection strategy.
评估T1期食管癌的淋巴结转移（LNM）模式及相关预后因素。回顾性分析2011年1月至2016年7月在天津医科大学肿瘤医院食管癌科接受食管切除术及淋巴结清扫术的143例pT1期食管癌患者的临床资料（男性120例，女性23例，中位年龄60岁），其中T1a期患者50例，T1b期患者93例。采用χ²检验和Logistic回归分析对LNM模式进行分析，并评估与LNM相关的预后因素。143例患者中，25例发生LNM。pT1期肿瘤的LNM率为17.5%，pT1a期肿瘤为16.0%（8/50），T1b期肿瘤为22.6%（21/93）。25例发生LNM的患者中，1例有颈部转移，15例有胸部转移，17例有腹部转移。LNM相对高发部位为喉返神经（8例）、胃左动脉（8例）、左右贲门（6例）和胸段食管旁（5例）。Logistic回归分析显示，肿瘤浸润深度（β =4.641，95%CI 1.279至16.836，P =0.020）、肿瘤大小（β =5.301，95%CI 1.779至15.792，P =0.003）、肿瘤位置（β =3.238，95%CI 1.248至8.401，P =0.016）和肿瘤分化程度（β =5.301，95%CI 1.719至16.347，P =0.004）是T1期食管癌LNM的独立预后因素。肿瘤大小（β =4.117，95%CI 1.228至13.806，P =0.022）是胸部LNM的独立危险因素，血管侵犯（β =6.058，95%CI 1.228至29.876，P =0.027）和肿瘤位置（β =8.113，95%CI 1.785 - 36.872，P =0.007）是腹部LNM的独立预后因素。T1期食管癌LNM率相对较高，肿瘤浸润深度、肿瘤大小、肿瘤位置和肿瘤分化程度与LNM相关。在制定更好的手术治疗和淋巴结清扫策略决策时，必须综合考虑LNM风险和范围。
